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Improving medical pathways for acute care

October 25, 2021

Dear ,


We are writing to draw your attention again to which we published in July 2020.


As medical royal colleges we are committed to improving medical pathways for acute care as we begin to recover from the second wave of the coronavirus pandemic. Recovery cannot take place without a transformation in the urgent and emergency care pathway, and multispecialty working is fundamental to that – all parts of the system must work together to provide safe and timely care.


As you know, the urgent and emergency care system faced significant problems before the coronavirus pandemic, including unsustainable crowding and corridor care in Emergency Departments. The pandemic, particularly the second wave, placed a considerable amount of additional strain: the numbers of patients waiting twelve hours or more in January 2021 was 34% higher than in January 2020.


 outlines key principles and ten important recommendations to support transformation of the urgent and emergency care pathway.


Amongst our recommendations, we call for:

  • Urgent expansion of same day emergency care (SDEC) options for primary care and 111. A wide range of generalist and specialist clinicians should be involved. This will mean more patients receive the right care at the right time.
  • All hospital specialties to prioritise patient flow and work to eliminate delay. Specialty referrals need a rapid response and a management plan that minimises unnecessary admission. This will enable us to quickly move patients from ambulances to be managed in safe areas.

Equality must be at the heart of transformation. Access to urgent emergency care is unequal, and as medical royal colleges we will continue to call on the Government to take greater action to reduce health inequalities via the . In the meantime, Trust leaders must consider the impact of any new changes so that new pathways of care do not exacerbate existing health inequalities.


We recognise the challenges to this work, but it is necessary, and we hope our report is useful. Please do feel free to contact us if you have any questions.


Yours sincerely,


Dr Katherine Henderson MB BChir FRCP FRCEM

President, Royal College of Emergency Medicine


Dr Andrew Goddard MD, PRCP

President, Royal College of Physicians

Dr Sue Crossland FRCP

President, Society for Acute Medicine

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